Ineffective appropriate shocks in coronary artery spasm disease: when defibrillation is not enough

  • Juan Benezet-MazuecosEmail author
  • José Antonio Iglesias
  • José Manuel Rubio
  • Pepa Sanchez-Borque
  • Angel Miracle


A 50-year-old woman without relevant medical history or risk factors received a single-chamber Fortify Assura (St Jude Medical) implantable cardioverter defibrillator (ICD) after recovering from sudden cardiac death (SCD). No structural heart disease was documented and coronary angiogram performed showed normal coronary arteries. Submuscular left-sided ICD implantation with dual-coil electrode was performed without incidences, defibrillation test was not performed. ICD was programmed in VVI 40 bpm for bradycardia and two zones for tachycardia settings (170–200 bpm monitor and > 200 bpm with maximum energy shocks: 36J+40Jx5, RV to SVC&can, biphasic, tilt 65%/65%, 5.6 ms). The patient was discharged and some weeks later was readmitted after syncope. ICD was interrogated showing a ventricular fibrillation (VF) episode that is correctly detected and treated with appropriate ICD shocks. Stored intracardiac electrograms showed ineffective shocks at maximum energy (Fig.  1a). ICD...


Coronary artery spasm Implantable cardioverter defibrillator Defibrillation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Myerburg RJ, Kessler KM, Mallon SM, Cox MM, de Marchena E, Interian A Jr, Castellanos A. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992;326:1451–1455.Google Scholar
  2. 2.
    Rodríguez-Mañero M, Oloriz T, le Polain de Waroux JB, Burri H, Kreidieh B, de Asmundis C, et al. Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm. Europace. 2018;20:851–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Takagi Y, Yasuda S, Tsunoda R, Ogata Y, Seki A, Sumiyoshi T, et al. Japanese Coronary Spasm Association. Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest: multicenter registry study of the Japanese Coronary Spasm Association. Circ Arrhythm Electrophysiol. 2011;4:295–302.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyHospital Universitario Fundación Jiménez Díaz-Quironsalud, Universidad Autónoma de MadridMadridSpain

Personalised recommendations